Sunday, November 18, 2018

Kentucky is one of three states under an influenza threat defined as "regional," with confirmed cases in 11 of the state's 17 regions. During the 2018-19 flu season, Kentucky has had 78 laboratory-confirmed cases of the flu and two deaths from it, according to the state Department for Public Health's weekly influenza surveillance report. The flu killed 325 Kentuckians in last year's season.

Flu is a very contagious disease caused by the influenza virus. There is no treatment for it, so health officials encourage everyone six months and older to get a flu shot, even if for those who are generally considered healthy -- including children.

A Centers for Disease Control and Preventionstudy looked at flu-related deaths in children younger than 18 over the course of six flu seasons from October 2010 through September 2016 and found that half of the deaths happened in otherwise healthy children, with most of them younger than 2. The report also shows that antiviral treatment was only given in about half of the children's deaths. The report notes that only 22 percent of the children were vaccinated.

Antiviral drugs can shorten the course of the illness or reduce its severity, but must be taken within two days of a person getting the flu.

"This study stresses how quickly the flu can become life-threatening for children. Nearly two-thirds of children died within seven days of developing symptoms. Over one-third died at home or in the emergency department prior to hospital admission. . . . This is a reminder that parents should seek prompt medical care for young children and children at high risk for flu complications with flu symptoms," says the CDC news release about the study.

Part of the problem in deciding whether to seek treatment or not is that flu symptoms are similar to cold symptoms, making it hard to differentiate between the two different viruses.

Davis notes that in general, flu symptoms are more intense than cold symptoms and can include fever, body aches, chills, and headaches, and can develop nausea and vomiting. He adds that while colds usually don't require medical care, if you suspect you have the flu you should see your health care provider.

He adds that unless you have a medical problem, most people don't need to seek care for a cold, and offers tips on when to seek medical care for flu. Here they are:

Fever that is continual or becomes high

Shaking chills

Coughing that produces bloody sputum and/or a greenish-yellow color

Difficulty breathing

Chest pain or chest pressure

Repeated nausea and vomiting

Confusion

Facial pain

Any uncertainty to whether you have a cold or flu during flu season

Davis also notes that if you have the flu you are typically contagious for about one to four days, though some can be contagious from about one day before the onset of symptoms for up to two weeks. For colds, most are contagious a day before the symptoms start and remain so for about five to seven days. He adds that children may be contagious for up to two weeks.

If you're looking for a place to get your flu shot, the CDC offers an interactive "flu vaccine finder" that allows you to type in your zip-code to find nearby locations that offer flu shots. Local health departments also offer the vaccine.

Saturday, November 17, 2018

As the full brunt of winter approaches, the state Department for Public Health offers tips on cold-weather preparedness to prevent hypothermia, carbon-monoxide poisoning and unsafe food from power outages. The message is part of a "First 72 On You" campaign to remind Kentuckians to be prepared to manage without help for at least three days in the event of a weather emergency.

Hypothermia happens when your body loses heat faster than it can produce heat, causing a dangerously low body temperature. If left untreated, it can affect the brain, making the victim unable to think clearly or move well. It can also lead to heart and lung failure, and even death.

Hypothermia is often caused by immersion in cold water, but can also be a result of exposure to extremely cold temperatures. The Centers for Disease Control and Prevention says it can also happen during cool temperatures (40 degrees) if a person is wet (from rain, sweat or cold water) and becomes chilled.

Symptoms include shivering; an altered speech pattern; abnormally slow rate of breathing; cold, pale skin; and lethargy. In infants, the symptoms include bright red or cold skin and very low energy levels. The health department advises that you seek medical attention if you or a loved one experiences the signs of hypothermia.

Here are the health department's tips to prevent hypothermia:

Wear appropriate clothing, including layers of synthetic and wool fabrics, hats, coats, scarves and gloves. The best outerwear is water-resistant.

Avoid consuming alcohol if outdoors, which can speed the loss of heat from the body.

Avoid activities that cause excessive sweat, which leads to damp clothing, and chilling.

Stay as dry as possible

Outdoor workers should take special precautions to stay warm and dry.

The CDC recommends making a car emergency kit that among other things includes extra hats,coats and mittens, blankets, a cell phone and portable charger, water, snacks, a working flashlight and jumper cables.

Carbon monoxide: State health officials warn Kentuckians that using alternative heating sources like portable generators, kerosene heaters, propane gas stoves and ovens heated with gasoline can lead to carbon-monoxide poisoning.

CDC graphic

Carbon monoxide is an odorless, invisible gas produced when gasoline, natural gas, propane, kerosene and other fuels are not completely burned during combustion. Breathing in carbon monoxide prevents the body from using oxygen normally, and can result in death.

Early symptoms of carbon-monoxide poisoning include headache, nausea, vomiting and fatigue. If you are experiencing symptoms or if you have questions, call the Poison Control Hotline at 1-800-222-1222.

On a Facebook live event on this topic, Dr. Ardis Hoven, a consultant with the department, noted that about 170 people die every year in the U.S. from carbon-monoxide poisoning and that the state has upwards of 180 cases reported each year. "And this is something that is preventable," she said.

Here are tips for avoiding carbon-monoxide poisoning:

Install battery-operated carbon-monoxide detectors in your home and replace the battery and device as required. If the detector sounds, leave your home and immediately call 911. It is recommended that a detector be placed outside each bedroom, on each level of the house, and in the basement.

Don’t use a generator, charcoal grill, camp stove or other gasoline or charcoal-burning device inside your home, basement or garage or near a window.

Don’t run a car or truck inside a garage attached to your house, even if you leave the door open.

Don’t burn anything in a stove or fireplace that isn’t properly vented. Have your chimney checked or cleaned yearly.

Don’t use a gas oven to heat your house.

Don’t place a portable heater within reach of children or pets, and don’t use a power strip or extension cord with it. Look for an Underwriter’s Laboratories (UL) safety label, and carefully read instructions before use.

Food safety: Power outages during extreme weather are something to plan for, especially when it comes to food safety and avoiding foodborne illness.

nutritionaction.com photo

The symptoms of foodborne illness include vomiting, diarrhea, abdominal pain, and flu-like symptoms such as fever, headache and body aches. The U.S. Food and Drug Administration says foodborne illness usually occurs within one to three days of eating the contaminated food, but can also occur within 20 minutes or up to six weeks later.

Here are some food safety tips:

Make sure you have appliance thermometers in your refrigerator and freezer.

Refrigerated foods should be safe as long as power is out for no more than four hours.

If the thermometer in the freezer reads 41 degrees Fahrenheit or below, or the food still contains ice crystals, the food is safe and may be refrozen.

Throw out any perishable food in your refrigerator, such as meat, poultry, lunch meats, fish, dairy products, eggs and any prepared or cooked foods that have been above 41 degrees Fahrenheit for four hours or more.

Fresh fruits and vegetables are safe as long as they are still firm and have no evidence of mold or sliminess.

Freeze refrigerated items that you may not need immediately to keep them at a safe temperature longer.

Have coolers on hand to keep essential items refrigerated if the power will be out for more than four hours.

Keep the refrigerator and freezer doors closed to maintain the cold temperatures.

Other advice includes having about three days of non-perishable food on hand in case of an emergency, refill medications before the bottle is empty during the winter months, and to make sure to have working flashlights in the home.

"Remember, the first 72 is on you," Doug Hogan, spokesman for the Cabinet for Health and Family Services, said on Facebook.

The U.S. Food and Drug Administration proposed Thursday to ban menthol-flavored cigarettes and cigars, and restrict the sales of some flavored electronic-cigarette liquids, some flavored cigars and the removal of e-cigarettes that are marketed to youth.

The proposals are aimed at curbing teen use of e-cigarettes and follow the release of data showing that teen use of these products increased 78 percent among high-school students and 48 percent among middle-school students in the past year.

The 2018 National Youth Tobacco Survey found that 3.6 million middle and high schools students are using e-cigarettes -- up from 1.5 million last year -- with more than 3 million, or 21 percent, of the students in high school and 570,000, or nearly 5 percent of them in middle school.

"It’s clear we have a problem with access to, and appeal of these products to kids, and we’re committed to utilizing the full range of our regulatory authorities to directly target the places kids are getting these products and address the role flavors and marketing are playing in youth initiation,” Dr. Scott Gottlieb, the FDA commissioner, said in a news release.

Explaining the menthol/mint ban, Gottlieb said it's not fair to create a market difference by limiting menthol and mint flavors in e-cigarettes when they are still allowed in combustible products.

The researchers attribute the surge in e-cigarette use to the popularity of the Juul and similar devices, because they resemble USB flash drives, allowing them to be used discreetly; have a high nicotine content; and come in kid-friendly flavors.

The new restrictions would require all vaping liquids flavored with anything other than tobacco, mint or menthol be sold only in stores that have strict age-checking practices. And if sold online, the flavored liquids must be sold under more stringent age verification rules, which will be forthcoming.

Gottlieb said the FDA would proceed with a proposed regulation banning flavored cigars, would issue a proposed rule to ban menthol cigarettes and cigars and will seek to remove any e-cig products that are marketed to youth, including those using cartoon or animated characters on the packaging.

Gottlieb said the package "reflects a careful balancing of public health considerations" between adults having access to a less harmful alternative than combustible cigarettes to quit smoking and preventing teen use. "But make no mistake," he warned. "If the policy changes that we have outlined don’t reverse this epidemic, and if the manufacturers don’t do their part to help advance this cause, I’ll explore additional actions."

Michigan Education Association photo

Juul Labs, which controls more than 70 percent of the market, announced earlier this week that, among other things, it will stop selling its mango, fruit, creme and cucumber pods in convenience stores and vape shops, and would shut down its social-media promotions and keep monitoring third-party accounts.

More bad news in youth tobacco survey

The jump in e-cigarette use supports the fears of health officials who have long been concerned that e-cig use by teens will reverse the declines in overall youth tobacco use. Multiple studies show that teens who use e-cigs are more likely to transition to cigarettes.

The youth tobacco survey found that in the last year, overall tobacco-product use among high-school students increased by 38 percent, rising to 27.1 percent from 19.6 percent, and among middle-school students by 29 percent, rising to 7.2 percent from 5.6 percent.

Not only is use of the products increasing, so is the frequency of use, which could indicate development of a habit that may be hard to stop. The survey found that the number of high-school students reporting they had used e-cigs on 20 or more of the past 30 days increased from 20 percent to nearly 28 percent in the past year.

More high school students reported having used flavored e-cigarettes in the past year; that figure rose to 68 percent from 61 percent. And current use of menthol- or mint-flavored e-cigs rose to 51.2 percent from 42.3 percent. Teens and young adults have told researchers that the flavors are the primary reason for their e-cig use.

Proposals spark debate

Gottlieb is getting some push-back from conservatives, but has held firm to his commitment to stop the teen use of these products.

“My former friends in the libertarian community who think this is emblematic of nanny-state government intervention and denying adults access to legal pleasures — I hope that when they sit and think about the data we’re seeing they’re willing to accept modest speed bumps in terms of the access adults will have to these products to hopefully close off the access of these products to kids,” Gottlieb told Paige Winfield Cunningham of The Washington Post.

In a detailed story in The Wall Street Journal about menthol products and "Big Tobacco," a spokesman for Reynolds American Inc., which makes Newport, the leading U.S. menthol brand, said banning menthols could possibly result in a legal battle, and a ban would also expand the underground market for these products, Jennifer Maloney and Tom McGinty report.

Matthew L. Myers, president for the Campaign for Tobacco Free Kids said in a news release that the menthol ban would "have a greater impact in reducing tobacco use by youth and the African-American community than any regulatory measure ever undertaken by the federal government."

But Myers argued that the FDA's e-cigarette proposal doesn't go far enough, because it stops short of banning many flavors that are highly popular with young people, noting that the menthol and mint flavors used by 51 percent of teen e-cig users will still be available.

"With these flavors still widely available, it is doubtful that this plan will stem the tide of youth e-cigarette use, and it will be critical for the FDA to quickly supplement the steps announced today," Myers said. "In addition, the Juul device itself and other e-cigarettes that deliver exceptionally high levels of nicotine will continue to be sold in convenience stores and gas stations."

Bonnie Hackbarth, a spokeswoman for the Foundation for a Healthy Kentucky, noted that the proposed regulatory changes can take years to implement and that there has already been "unnecessary delays" in the e-cigarette regulations, which have allowed new products to "flourish."

"We’re heartened by the FDA’s stepped-up enforcement and by what appears to be a clear-minded attempt to balance the absolute necessity of keeping tobacco products out of the hands of kids while allowing adults who smoke access to products that may help them quit tobacco completely," she said. "But we can’t wait two more years or even another six months, only to find that e-cig flavors and easy access have hooked millions more kids to a deadly habit."

Ben Chandler, president and CEO of the foundation, said, "Flavored cigarettes were banned in 2009 largely because the colorful packaging and names appealed to youth, which is the age most smoking habits are established. The explosive growth in teen use of Juul and other pod e-cigarettes in recent months, in conjunction with research showing that most youth try flavored e-cigarettes first . . . just proves the point. Flavors are a powerful tool in the tobacco business-model toolbox that relies on addicting new customers to stay in business. Unless and until it's proven that flavored e-cigs actually do help adult smokers quit, they shouldn't be allowed on the market."

The General Assembly passed the law in 2017 at the behest of doctors and nursing homes, which had long lobbied for it, and also by "hospitals and other health providers as means to limit what they claimed were frivolous lawsuits," notes Deborah Yetter of the Louisville Courier Journal.

The court "said the law is unconstitutional because it delays access to the state’s courts for adjudication of common-law claims," Jack Brammer reports for the Lexington Herald-Leader.

Chief Justice John Minton wrote in the ruling, upholding Franklin Circuit Judge Phillip Shepherd, “Of all the rights guaranteed by state constitutions but absent from the federal Bill of Rights, the guarantee of a right of access to the courts to obtain a remedy for injury is possibly the most important.”

The bill's main sponsor, Sen. Ralph Alvarado, R-Winchester, said in August that if the law were overturned, he would favor a constitutional amendment to allow it. Section 64 of the state constitution bans limits on the right to recover damages, and business interests have long wanted to change or repeal it. When Republican Gov. Matt Bevin signed the measure into law, he called it it "the first step toward tort reform."

The Kentucky Medical Association said it was “extremely disappointed” because “Kentucky now remains one of the few states in the country with no meaningful tort reform.”

"The law requires that claims filed against doctors, hospitals, nursing homes, their executives and other health care providers must first be evaluated by panels composed of three medical providers before proceeding in court. The panels’ opinions could be entered as evidence in any subsequent litigation," Brammer recounts. "Shepherd struck down the law in October 2017, saying it 'protects the economic interests of the health-care industry at the expense of consumers, with no demonstrable benefit to the public at large.' The case bypassed the Kentucky Court of Appeals," but Shepherd allowed the law to remain in effect on appeal.

"The law had created a large backlog of several hundred malpractice cases awaiting assignment and review by state-appointed panels before they could proceed to court, while relatively few cases had been decided,' Brammer reports. "It's not clear what will happen to those cases now," Yetter writes.

Wednesday, November 14, 2018

Kentucky continues to make progress in expanding the number of children with health insurance, having fewer low-birthweight babies, and lowering rates of teen pregnancy and smoking during pregnancy, but it has high rates of children living in out-of-home care because of abuse or neglect, according to the annual Kentucky Kids Count report. It shows those rates vary widely by county.

The report, released Tuesday by Kentucky Youth Advocates and the Kentucky State Data Center at the University of Louisville, is part of the 28th annual release of the County Data Book, which provides data on overall child well-being through 17 measures in four areas: economic security, education, community strengths, and health and family. Nearly one in four Kentuckians are children.

A bright spot in the report is that fewer Kentucky women are smoking during pregnancy.

Statewide, the report found that rates of smoking during pregnancy dropped to 18.1 percent in 2014-16, from 21.3 percent in 2009-11, with 110 of the state's 120 counties showing improvement.

"Tobacco addiction is so difficult to break, but this report is proof positive that women all over Kentucky are finding a way to protect their babies from the dangers of smoking while pregnant," Ben Chandler, president and CEO of the Foundation for a Healthy Kentucky, said in a news release. "They're reducing the risk that their babies will be born with birth defects or die suddenly without explanation during infancy. And they're increasing the chances their babies will be born full-term and at a healthy weight."

Seventy-three counties saw a reduction in low-birthweight babies. Statewide, this rate dropped to 8.8 percent in 2014-16, from 9 percent in 2009-11.

And while smoking during pregnancy declined in Lee and Owsley counties, more than 40 percent of expectant mothers in those counties smoked in 2014-16 -- and 22 counties had smoking-during-pregnancy rates of 30 percent or higher.

The state's teen-pregnancy rate continues to drop. It declined to 31.7 teen births per 1,000 females aged 15-19 in 2014-16, down almost a third from 45.9 per 1,000 five years earlier. Kentucky's rate still remains about half again as high as the national rate, 20.3 teen births per 1,000.

Differences between counties remained great, ranging from a low of 7.9 teen births per 1,000 in Oldham County to a high of 79.5 teen births per 1,000 in Elliott County. And while 108 counties saw a drop in their teen-birth rates, several of the remaining 12 had large increases, including: Lawrence County by 14 points, to 52.4 per 1,000; Lee County, up 10 points to 49.6 per 1,000; and Menifee County, up by 12, to 59.6 per 1,000.

Other key findings about Kentucky's children in the report:

Nearly 97 percent of Kentucky's children have health insurance, and all 120 counties showed improvement.

One in four Kentucky children live in poverty, defined as annual household income of $24,339 or less for a family of four. The good news is that this rate decreased in 93 of the 120 counties.

The rate of children in out-of-home care increased in 92 counties, "fueled by parents struggling with addiction." Elliott County had the highest rate, with 118.2 in out-of-home care per 1,000 children aged 10-17. The state rate is 43.7 per 1,000.

The number of children being raised by a relative has increased by 75 percent, from 55,000 in 2012-14 to 96,000 in 2016-18.

119 of 167 school districts saw an increase in the rate of students graduating on time; graduation rates declined in 46 districts. About 90 percent of Kentucky's high-school students graduate on time.

This year's report also explores the issue of child abuse in Kentucky, noting that 20 of every 1,000 children in the state experienced abuse and neglect in 2016, more than twice the national average. As part of a five-page essay, titled "Putting a Plug in the Abuse to Prison Pipeline," the report calls for "collective engagement across systems" to tackle the issue.

“These pressing challenges call for smart policies, innovative solutions, and focused attention on our priorities,” Dr. Terry Brooks, executive director of KYA, said in a news release. “The more we support all Kentucky children to grow up healthy, hopeful, and contributing to the community, the brighter our future looks.”

The Kids Count Data Center is also available for a deeper dive into the data. It offers a profile sheet for every county that shows rankings and can be used to create maps and charts for comparisons.

KYA will hold "Kids Count Conversations" in Paducah, Glasgow, Louisville, Manchester and Covington to help community leaders use local data to inform policy that impacts their youth. E-mail KYA at kidscount@kyyouth.org if you would like to have such a conversation in your community.

The 2018 County Data Book was made possible with support from the Annie E. Casey Foundation and local sponsors Passport Health Plan, Delta Dental of Kentucky and Kosair Charities.

Tuesday, November 13, 2018

The Community Leadership Institute of Kentucky, which provides research and leadership training, funding and technical support for health-related research projects, is accepting applications for its 2019 class.

Among other things, participants will gain a broader perspective of community health issues, improve their grant-writing skills, learn how to create databases and better surveys, and enhance their leadership skills. The program's goal is to engage and empower communities to reduce health disparities, leverage funding and learn how to use data to improve services and programs.

Each participant's organization will also receive a $2,500 grant for their participation in the program and upon completion of their proposed project, with some additional requirements.

Priority will be given to leaders from Appalachian Kentucky and to projects related to cancer prevention (e.g., nutrition, physical activity, smoking cessation), reducing obesity and sedentary lifestyle, prevention and management of chronic diseases (e.g., diabetes and cardiovascular disease), and prevention and treatment of substance abuse.

The sessions will be held at the University of Kentucky Center for Excellence in Rural Health in Hazard. Click here for a list of dates. Applications are due by Tuesday, Dec. 18, for approximately 12 available slots. Contact Beth Bowling at beth.bowling@uky.edu or 606-439-3557, ext. 83545 for more information.

CLIK is offered through a partnership of the center, the UK Center for Clinical and Translational Science Community Engagement and Research Program and the Kentucky Office of Rural Health.

Sunday, November 11, 2018

Cigarette smoking rates have hit their lowest level ever, but 47 million Americans still use some type of tobacco-based product, prompting government officials to say there's more work to do.

Smoking rates among adults dropped to about 14 percent in 2017 from 15.5 percent in 2016, according to the Centers for Disease Control and Prevention, the Food and Drug Administration and the National Cancer Institute. That's a drop of two-thirds from 42 percent in 1965, the first year national smoking rates were recorded.

The current rate for young adults 18 to 24 dropped even more than the overall rate, to 10 percent in 2017 from 13 percent in 2016.

However, use of electronic cigarettes among young people is burgeoning, and one in five Americans, still use some type of tobacco-based product, and 34 million of the 47 million users still smoke. Kentucky's latest reported adult smoking rate is 24.5 percent.

The national figures were published in the CDC's Nov. 9 Morbidity and Mortality Weekly Report. Using data from the 2017 National Health Interview Survey, the CDC found that use of tobacco-based products was highest among people with a high-school equivalency diploma or GED (43 percent), those without health insurance (31 percent), people on Medicaid (28 percent) or other public insurance (27 percent), people who are lesbian, gay or bisexual (27 percent), people with an annual household income under $35,000 (26 percent), people with a disability (25 percent) and in the Midwest or South.

"Demographic and geographic tobacco-use disparities make clear that we have much work to do, especially in states like Kentucky," Ben Chandler, president and CEO of the Foundation for a Healthy Kentucky, said in a news release. "The latest numbers point the way for health advocates: we must focus our efforts to counter tobacco industry targeting of lower-income, less-educated, and minority populations."

In addition to the 14 percent of U.S. adults who self-identified as cigarette smokers in 2017, 3.8 percent said they smoked cigars, cigarillos or filtered little cigars; 2.8 percent said they used electronic cigarettes, 2.1 percent said they used smokeless tobacco, and 1 percent said they used pipes, water pipes or hookahs. About 9 million tobacco users, or 19 percent, reported using two or more tobacco products, with cigarettes and e-cigarettes as the most common combination.

Chandler stressed that it's important to continue to watch how e-cigarettes affect behavior and health.
"The jury is still out on whether they will reduce overall tobacco use and illness among adults or, because of the explosion in teen e-cigarette use, end up addicting a whole new generation or creating a whole new set of health issues," he said.

The CDC report calls for comprehensive tobacco-control programs at national, state and local levels, noting such strategies and interventions as its Tips From Smokers campaign, the FDA's "Every Try Counts" campaign and the cancer institute's Smokefree.gov and toll-free quitline (1-800-QUIT NOW).

The president of the Campaign for Tobacco-Free Kids, Matthew L. Myers, offered other policy suggestions.

Smoking is considered the leading cause of preventable death, killing more than 480,000 Americans a year at a cost of $170 billion annually for related health care expenses, according to the CDC. About 16 million Americans suffer from a smoking-related illness.

“For more than half a century, cigarette smoking has been the leading cause of cancer mortality in the United States,” NCI Director Dr. Norman E. Sharpless said in a news release. “Eliminating smoking in America would, over time, eliminate about one-third of all cancer deaths.”

The latest report did not reveal updated youth tobacco use rates, which are expected to be released within the next few weeks. State-level data require more processing and are issued after national figures.

Saturday, November 10, 2018

Rural communities have unique health-care needs: accessibility, a lack of providers, the needs of an aging population suffering from a greater number of chronic conditions, and larger percentages of people without health insurance or enough insurance. On top of that, rural hospitals – many of which are local economic linchpins – struggle with declining government reimbursements and the lack of Medicaid expansion in many states.

For these reasons and more, the National Organization of State Offices of Rural Health observes each third Thursday of every November – this year, Nov. 15 – as National Rural Health Day. "First and foremost, National Rural Health Day is an opportunity to 'celebrate the power of rural' by honoring the selfless, community-minded, can-do spirit that prevails in rural America," NOSORH says. "But it also gives us a chance to bring to light the unique healthcare challenges that rural citizens face – and showcase the efforts of rural healthcare providers, state Offices of Rural Health and other rural stakeholders to address those challenges."

Friday, November 9, 2018

A nonprofit group that rates hospitals has released its latest grades for keeping patients safe, giving Cs to most of the 51 Kentucky hospitals it rated. Their average grade was worse than the spring 2018 ratings, but Kentucky's overall ranking among the states, based on the percentage of hospitals with A grades, improved one spot, to 33rd, from the spring report.

Ky. Health News chart based on Leapfrog Group data and logo

The Leapfrog Group, a nonprofit group based in Washington, D.C., rated over 2,600 hospitals. Most of Kentucky's 129 hospitals were not rated, since rural hospitals with "critical access" status don't have to report quality measures to the federal government.

The grades are calculated using 28 performance measures of patient safety that indicate how well hospitals protect patients from preventable medical errors, infections and injuries. The study notes that one in 25 patients leave hospitals with a new infection. It uses data from the Centers for Medicare and Medicaid Services, Leapfrog's own survey, and the American Hospital Association's annual survey and information-technology supplement.

Leapfrog gave As to 12 Kentucky hospitals, or nearly 24 percent of those graded, lower than the national average of 32 percent. It gave Bs to 12, Cs to 23, and Ds to 4. None got a failing grade. Compared to the spring report, five fewer hospitals got Bs and 10 more got Cs.

Low scorers

Highlands Regional Medical Center in Prestonsburg got its second D in a row. Methodist Hospital of Henderson got its first D, and two Louisville hospitals that are consistent low scorers, Jewish Hospital and the University of Louisville Hospital, again got Ds.

Sts. Mary & Elizabeth Hospital in Louisville moved up to a C after receiving five Ds in a row.

Pikeville Medical Center kept its C for a second straight report card, after getting all As before that.High scorers

The St. Elizabeth Healthcare hospitals in Edgewood, Florence and Fort Thomas all got As. so did Baptist Health Lexington, TriStar Greenview Hospital in Bowling Green and Whitesburg ARH Hospital.Norton Audubon Hospital and Norton Hospital, both in Louisville, got their first As, both having received a mix of Bs and Cs since spring 2015.

Georgetown Community Hospital again got an A, after getting a B in the spring and a C last fall.

Clark Regional Medical Center in Winchester got its first A, having received two Cs and three Bs since spring 2016, the first time it was graded.

Harrison Memorial Hospital in Cynthiana and Middlesboro ARH Hospital, which had not been ranked for several years, also got As.

Moving down: examples

The two University of Kentucky hospitals dropped to a C. Both had received Bs since fall 2016.

Hardin Memorial Hospital in Elizabethtown got a C, dropping from an A in the last two reports.

Murray-Calloway County Hospital dropped to a C after having received all As since fall 2015.

Baptist Health Richmond got its first C, having received two As and five Bs since spring 2015.

Our Lady of Bellefonte Hospital in Ashland dropped to a C after having received all Bs since fall 2016.Frankfort Regional Medical Center dropped to a B after receiving all As since spring 2015.

Moving up: examplesLourdes Hospital in Paducah got a B, after having received Ds in the last two grading periods and Cs prior to that.

T.J. Samson Community Hospital in Glasgow got a B after receiving four Cs in a row.

Harlan ARH Hospital got a B, having received no score in the spring and Cs since the spring of 2017.

Jewish Hospital Shelbyville got a B after not getting a score since the spring of 2017 and having received two Cs prior to that.

Taylor Regional Hospital in Campbellsville moved back up to a C after getting a D in the spring. With the exception of that D, the hospital has received Cs since spring 2015.

The Leapfrog Group says its analysis was developed under the guidance of the nation's leading patient-safety experts and is peer-reviewed. Click here to see all of Kentucky hospital's Leapfrog hospital safety grades. Click here for Leapfrog recommendations on how to use the grades.

Teens who use electronic cigarettes end up smoking traditional cigarettes at about the same rate as teens who first start with the traditional smokes, according to a recent study based on surveys in California and Connecticut.

“The findings show that e-cigs do nothing to deter the amount of combustible smoking in youth,” Jessica Barrington-Trimis, an assistant professor of preventive medicine at the University of Southern California and the study’s lead author, said in a news release. “On the contrary, they increase the likelihood that vaping teens will start smoking.”

The study, published in the medical journal Pediatrics, is based on surveys of 6,258 high-school students in three studies, including two from the Children's Health Study and Happiness and Health Study in Southern California and a Yale University survey in Connecticut. Participants were re-surveyed again six to 16 months later.

During the study period, 7 percent of the students initially identified as never-smokers, and 21 percent of those who were using e-cigs, began smoking traditional cigarettes. And once they started smoking them, the amounts the two groups smoked were similar.

The study also found that students who only smoked cigarettes, or used both products, were more likely to continue using cigarettes than they were to switch to e-cigs only, or to quit smoking altogether.

The report notes that numerous studies show that young people who use e-cigarettes are more likely to start smoking.

"Because e-cigarettes are used by at least some youth who likely would not ever have begun smoking without having been exposed to e-cigarettes, the potential negative impact of e-cigarettes on the health of youth via the effect of e-cigarettes on smoking uptake is concerning," the report says.

It called for policies to reduce teen use of both products "to prevent progression to more frequent tobacco-use patterns, and to reduce combustible cigarette use (with or without concurrent e-cigarette use) to lessen the adverse public health impact of e-cigarettes."

Coalition for a Smoke-Free Tomorrow chart

Ben Chandler, president and CEO of the Foundation for a Healthy Kentucky, said in a news release that it's time to make local and state tobacco controls include e-cigarettes and other vaping products, since research continues to show e-cigarettes are a "gateway to smoking for youth and young adults."

"Our tobacco-control policies at the national, state and local levels must be updated to reflect that youth e-cigarette use has risen to epidemic levels, potentially reversing all the progress we've made in reducing smoking rates over the past 50 years," Chandler said. "At a minimum, that means enacting tobacco-free school policies that prohibit the use of all tobacco products -- including combustible cigarettes as well as vapes, e-cigarettes and other electronic nicotine delivery systems, or ENDS -- on or in school property. And it means including these products in smoke-free community policies."

The latest Kentucky Health Issues Poll showing 87 percent of Kentucky adults support 100 percent tobacco-free schools, but state legislation to do that has failed, and as of July, only 42 percent of the state's 173 school districts were covered by 100 percent tobacco-free policies.

About the same number of Kentucky high-school students smoke cigarettes as use e-cigs, 14 percent. Nationally, 8.8 percent of teens smoke and 13.2 percent use e-cigarettes.

FDA action coming

The U.S. Food and Drug Administration has been cracking down on the sale of e-cigarettes and other vaping products to minors, and is expected to impose severe restrictions on their sale as early as next week, Laurie McGinley reports for The Washington Post.

Citing senior agency officials, the Post says FDA Commissioner Scott Gottlieb is expected to announce a ban on the sale of most flavored e-cigs in convenience stores and gas stations, impose age-verification requirements for online sales, and propose banning menthol in regular cigarettes.

"The FDA’s initiatives on vaping are spurred by preliminary government data that show ­e-cigarette use rose 77 percent among high schoolers and nearly 50 percent among middle schoolers in 2018. That means 3.5 million children were vaping in early 2018, up 1 million from 2017," McGinley reports.

Six organizations that have been on the front lines in the fight against tobacco asked Gottlieb in a letter Nov. 10 for "action that will ensure that we don’t addict another generation of American youth." The letter from the American Academy of Pediatrics, the American Cancer Society, the American Heart Association, the American Lung Association, the Truth Initiative and the Campaign for Tobacco-Free Kids lists "core principles essential to reducing tobacco use:"

Voluntary action by the industry, including the electronic cigarette industry, is insufficient. Industry-wide regulatory action is essential; FDA’s approach must be comprehensive and not be limited to sales restrictions to prevent illegal sales to youth. and it is essential to address the problem of youth use of other tobacco products as well as e-cigarettes.

The groups called for FDA to take specific actions, including immediate removal of all flavored tobacco products that have not been thoroughly vetted in advance by FDA to assess their public health impact; restrictions on e-cigarette marketing, including on social media, that are at least as stringent as those applied to cigarettes; restriction of online sales and continued aggressive enforcement of the law against sales to minors; and enforcement of the legal requirement for pre-marketing review of products that were not commercially marketed as of Aug. 8, 2016.

Thursday, November 8, 2018

A food service employee at the Albert B. Chandler Hospital at the University of Kentucky has been diagnosed with hepatitis A, a highly contagious liver disease, the hospital announced.

The employee prepared food at the Pavilion A cafeteria, but was not involved in any food preparation for hospital patients. The hospital advises anyone who ate at the cafeteria between Oct. 11 and 30 to get a hepatitis A vaccination, which requires two shots, six months apart.

All food-service workers at UK HealthCare will now be required to get the vaccine, and the hospital will set up "vaccination stations" for that.

The Lexington-Fayette County Health Department and UK HealthCare have recommended that all Lexington residents get vaccinated as the number of cases continues to climb. Kentucky schoolchildren were required to have the vaccination at the beginning of the school year.

In the current outbreak, there have been no confirmed cases of hepatitis A being transmitted by food-service workers in Kentucky. The primary risk factors continue to be illicit drug use and homelessness.

Since August 2017, 2,410 cases of acute hepatitis A have been reported in 94 of the state's 120 counties, resulting in 1,267 hospitalizations and 16 deaths, according to the state Department of Public Health. The agency's weekly report has county-by-county figures.

Last week, two people died in Franklin County from the virus and an employee at Frisch's Big Boy on Harrodsburg Road was diagnosed with it -- the first time a restaurant worker had been diagnosed with the disease in Lexington since the outbreak, the Lexington Herald-Leader reported.

Hepatitis A is a contagious liver disease that is usually spread when a person unknowingly eats or drinks something contaminated with by small amounts of fecal material from an infected person. Washing your hands for about 20 seconds with soap and water after using the bathroom or changing a diaper, or before preparing food and drinks can help stop the spread of hepatitis A. It is important to note that hand gels are not an alternative because they do not kill the virus that causes hepatitis A.

Symptoms of hepatitis A are fatigue, decreased appetite, stomach pain, nausea, darkened urine, pale stools and yellowing of the skin and eyes (jaundice). Not everyone with the virus has symptoms and a person with the virus is contagious for up to two weeks before showing symptoms. People can become ill 15 days to 50 days after being exposed to the virus. Anyone experiencing symptoms should seek medical attention.

Abby Drane has been named Kentucky regional CEO for Centerstone, a non-profit organization that cares for patients with mental, developmental and behavioral issues. She will replace Tony Zipple, who is retiring Nov. 30.

Drane was president and CEO of Uspiritus, which serves abused and neglected youth in Kentucky, and before that was Centerstone's chief operating officer. She has served as chief financial officer for two of Kentucky’s largest community mental health centers, Seven Counties Services (now Centerstone) and Communicare.

Drane earned a bachelor's degree in accounting from Central Missouri State University and her MBA from Western Kentucky University.

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Kentucky Health News is an independent news service of the Institute for Rural Journalism and Community Issues, based in the School of Journalism and Media at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.Republication of any KHN material with proper credit is hereby authorized, but if the republication is longer than a news brief we ask that it contain the first sentence of this paragraph. For our site that features articles of lasting importance, go here.